Subtypes of patients experiencing exacerbations of COPD and associations with outcomes.
Subtypes of patients experiencing exacerbations of COPD and associations with outcomes.
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DOI：
10.1371/journal.pone.0098580
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
IRYSS-COPD Group
中科院分区：
文献类型：
--
作者：
Arostegui I;Esteban C;García-Gutierrez S;Bare M;Fernández-de-Larrea N;Briones E;Quintana JM;IRYSS-COPD Group
慢性阻塞性肺疾病（COPD）是一种复杂且异质的疾病，其特征是偶尔恶化。识别慢性阻塞性肺病急性加重 (ECOPD) 患者的临床亚型有助于更好地了解急性加重的病理生理机制，制定不同的治疗策略，并改善护理过程和患者预后。本研究的目的是使用临床变量来识别急诊科就诊的 ECOPD 患者的亚型，并使用多种结局来验证结果。我们评估了在西班牙 16 家医院进行的 IRYSS-COPD 前瞻性队列研究中收集的数据。从急诊科之一的 ECOPD 患者收集的变量包括动脉血气、合并症的存在、既往 COPD 治疗、COPD 的基线严重程度以及之前因 ECOPD 住院的情况。通过结合多重对应分析和聚类分析的结果来识别患者亚型。使用 ECOPD 演变的关键结果对结果进行了验证。根据当前恶化的严重程度和一般健康状况（很大程度上是合并症的函数），确定了四种 ECOPD 亚型： A 亚型（n = 934），既不高合并症也不严重恶化； B 亚型 (n = 682)，中度合并症； C 亚型 (n = 562)，与死亡相关的严重合并症；和 D 亚型（n = 309），非常严重的恶化过程，与死亡率和入住重症监护室显着相关。 D 亚型的死亡率、入住重症监护室和需要无创机械通气的比率最高，其次是 C 亚型。A 和 B 亚型主要与其他严重并发症有关。所有亚型的住院率均超过 50%，但 C 和 D 亚型的住院率明显高于 A 和 B 亚型。这些结果有助于确定特征，对 ECOPD 患者进行分类以获得更适当的护理，并有助于测试进展和结果较差的亚组中的干预和治疗。
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.
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影响因子：
24.3
作者：
Mannino, D. M.;Thorn, D.;Holguin, F.
通讯作者：
Holguin, F.
影响因子：
2.8
作者：
Quintana JM;Esteban C;Barrio I;Garcia-Gutierrez S;Gonzalez N;Arostegui I;Lafuente I;Bare M;Blasco JA;Vidal S;IRYSS-COPD Group
通讯作者：
IRYSS-COPD Group
DOI：
10.1164/rccm.201207-1299oc
发表时间：
2012-11-15
影响因子：
24.7
作者：
Lange, Peter;Marott, Jacob Louis;Nordestgaard, Borge Gronne
通讯作者：
Nordestgaard, Borge Gronne
影响因子：
24.3
作者：
Esteban, C.;Arostegui, I.;Capelastegui, A.
通讯作者：
Capelastegui, A.
DOI：
10.1164/rccm.200711-1754oc
发表时间：
2008-08-01
影响因子：
24.7
作者：
Haldar P;Pavord ID;Shaw DE;Berry MA;Thomas M;Brightling CE;Wardlaw AJ;Green RH
通讯作者：
Green RH